Apparatus for intraocular surgery

ABSTRACT

A pneumatically operated intraocular surgery apparatus which is of very light weight and small size, the part inserted into the eye having a diameter of 1 mm. or less. One embodiment of the invention employs a high frequency electric current electrode for cutting or severing vitreous or other material, said electrode being provided with means for removing coagulated material adhering thereto. Other embodiment of this invention which are also of very small size and light weight employ concentric tubes with a pneumatic means for moving one of the tubes with respect to the other at a slow or fast rate so that vitreous sucked into one of the tubes is sheared off by the sharp end of the other tube and the severed vitreous is sucked into a calibrated cylinder and at the same time saline solution is automatically supplied to the eyeball to replace the removed vitreous.

United States Patent OMalley et a1.

[ APPARATUS FOR INTRAOCULAR SURGERY [76] Inventors: Conor C. OMalley, 1323 Glen Eyrie Ave., San Jose, Calif. 95125; Ralph M. Heintz, Sr., PO. Box 546, Los Gatos, Calif. 95030 [22] Filed: June 19, 1972 [21] Appl. No.: 264,166

[52] US. Cl. 128/305, 128/276 [51] Int. Cl. A6lb 17/32, A6lm 1/00 [58] Field of Search 128/2 B, 276, 297, 305, 128/31 1 [56] References Cited UNITED STATES PATENTS 1,677,209 7/1973 Rose 128/305 X 3,173,414 3/1965 Guillant 128/2 B 3,289,669 12/1966 Dwyer et al [28/2 B FOREIGN PATENTS 0R APPLICATIONS I 1,161,400 3/1958 France 128/2 B OTHER PUBLICATIONS Peyman et a1., Experimental Vitrectomy," In Arch.

[111 3,815,604 [4 1 June 11, 1974 Ophthal. 68: 548-551. November 1971.

Primary Examiner-Channing L. Pace Attorney, Agent, or Firm-Allen & Chromy 5 7 ABSTRACT A pneumatically operated intraocular surgery apparatus which is of very light weight and small size, the part inserted into the eye having a diameter of 1 mm. or less. One embodiment of the invention employs a high frequency electric current electrode for cutting or severing vitreous or other material, said electrode being provided with means for removing coagulated material adhering thereto. Other embodiment of this invention which are also of very small size and light weight employ concentric tubes with a pneumatic means for moving one of the tubes with respect to the other at a slow or fast rate so that vitreous sucked into one of the tubes is sheared off by the sharp end of the other tube and the severed vitreous is sucked into a calibrated cylinder and at the same time saline solution is automatically supplied to the eyeball to replace the removed vitreous.

11 Claims, 19 Drawing Figures PATENTEDJUN 1 1 I874 3.8 151604 sum 1 or 5 FIG.4

PATENTEDJUM 1 1 1924 SHEET 3 OF 5 l APPARATUS FOR INTRAOCULAR SURGERY DESCRIPTION OF THE INVENTION This invention relates to apparatus for use in effecting intricate surgery such as performed by an ophthalmic surgeon.

In certain diseases of the eye or in certain trauma it is necessary to sever the vitreous which is a relatively complex substance composed of a framework of long protein molecules with patches of other protein molecules positioned at the intersections where the long protein molecules (collagen) are. In addition the vitreous also includes patches or balls of a second protein molecule (hyaluronic acid) which help to strengthen the vitreous and maintain its form and assist in holding water which comprises over 99 percent of the vitreous. The surgeon then finds it necessary to remove the severed vitreous or extraneous matter from within the vitreous and this removal must be accomplished without damage-to the retina, to the choroid which underlies the retina or to the optic nerve or to the blood vessels associated therewith. This, of course, is no easy task as the vitreous can not be cut by a scalpel or other similar instrument since the vitreous is relatively toughand simply folds over the edge of the knife and refuses to be severed. Various devices have been proposed for vitreous surgery and reference is made to such devices in the following published articles.

G. C. Couvillion, H. M. Freeman, and C. L. Schepens on pages 722 and 723 of Volume 83, June 1970, Arch Ophthal, describe vitreous surgery using scissors. Robert Machemer, Jean-Marie Pare] and E. W. D. Norton on pages 462 to 466 of Volume 76, March-April 1972, Tr. Am. Acad. Ophth. and Owl, describe a vitreousinfusion-suction-cutter for vitrectomy. The cutter described in this article is provided with a rotating inner tube that is pushed bya spring against an end of an outer tube. A cutting'hole which is slightly laterally displaced, is provided in the end of the tip. In another article entitled Experimental V itrectomy, in Volume 86, November, 1971, Arch Ophthal, G. A. Peyman and M. A. Dodich describe an instrument for cutting vitreous strands by a chopping action produced by an inner tube against the plane end of an outer tube. The vitreous to be removed is drawninto the inner tube by suction provided in the inner tube. In this device another tube is attached alongside the outer tube and saline solution is supplied through this tube to replace the removed vitreous. In this device the chopping action is produced by oscillating the inner tube to 50 times per second and this is achieved by electrically energizing a small solenoid that is attached to the inner tube. i

Probes energized by radio frequency electric currents have also been used in ophthalmic surgery and one such deviceis described by G. A. Peyman and N. A. Dodich on pages 29 to 37 of the January February 1972 issue of Ophthalmic Surgery. This article describesthe useof a radio frequency electric current energized probe'for intraocular coagulation. The May, 1954 issue of the American Journal of Ophthalmology contains an article by Angelos Dellaporta in which he describes a deviceusing an insulated transbulbar needle 30 mm. in length which is connected to an electric current supply and is used to seal retinal holes. This device, according to this article is manufactured by C. Reiner, Mariannengasse, Vienna 9. The June, 1970 issue of Arch Ophthal contains an article by W. D. Cockerham, C. L. Schepens and H. MacKenzie Freeman entitled Silicone Injection in Retinal Detachment. The authors describe a procedure in which a 10 cc syringe which is attached to a blunted No. l8 or No. 20 needle is inserted into the eye through a meridional sclerotomy placed in the middle of the pars plana ciliaris for silicone injection.

It is therefore an object of our invention to provide an improved apparatus for cutting vitreous, severing adhesions and sealing blood vessels or severing them without causing hemorrhage.

Another object of our invention is to provide an improved device for operations such as cutting vitreous and sealing blood vessels that might be displaced or have become dislodged from the retina and migrated or grown into the body of the vitreous, said improved device enabling the surgeon to perform such operations with a minimum of likelihood of hemorrhage either while cutting the vitreous or during a separate procedure.

Still another object of our invention is to provide improved tools for use of eye surgeons, said tools being so small that they may be inserted into the eye through'the pars plana.

A further object of our invention is to provide improved tools foruse by eye surgeons, the portion of the tool to be inserted into the eye having a diameter of 1 mm., or less and the whole instrumentbeing small and lightweight so that it can be hand-held and manipulated with ease and with minimal damage to the eye.

Other and further objects of our invention will be apparent to those skilled in the art to which it relates or will be pointed out in detail in the following specification, claims and drawing.

. By this invention we have provided the eye surgeon with an operating tool that is characterized by its extremely small size and light weight for performing surgery within theeye of the patient. We have developed two types of mechanical vitreous cutting instruments and one high frequency electrical cutting instrument. All of these instruments may of course beused for cutting material other than vitreous bythe operating surgeon. One of the mechanical devices is referred to as the push-cut and the other is referred to as the pull-cut. Both of these instrumentshave the same dimensions and weight (about 4 grams) and in each case the length is about 2 inches overall with the body thereof having a length of 1 inch and the cutting tube also having a length of 1 inch. The diameter of the cutting tube is 0.035 inch (0.9 mm.). The push-cut instrument comprises a cylinder with a piston sliding within it and the cutting tube is rigidly fastened to the piston and passes .the inner tube to be sprung out slightly so that the sharpened end of the inner tube is pressed tightly against the inner surface of the outer tube thereby insuring a good shearing action when the sharp end of the 'inner tube passes the port opening in the outer tube.

Vitreous to be severed is drawn into the port of the outer tube by suction and this vitreous is cut off when the piston moves the inner tube so that the sharp end thereof crosses the port of the outer tube. The frequency of the traverse of the cutting end of the inner tube across the port of the outer tube is controlled by an electrical circuit which generates timed electrical pulses for controlling air pressure and suction pulses to the piston of the cutting device. This frequency may be controlled by a foot actuated device which is operated by the surgeon employing this instrument. Thus, this frequency may be varied from a stationary condition with the port either open or closed to as many as 60 traverses per second or more. The speed of excursion is dictated by the nature of the material being cut, its proximity to the retina, the optic nerve, blood vessels or other sensitive regionsfAir pressure and suction are applied to the piston of the cutting device through a flexible tube having a diameter of about one-eighth inch with a bore of about one-sixteenth inch. The debris tube is positioned inside of the pressure and suction tube and it has an outside diameter of about 0.035 inches and an inside diameterof 0.020 inches. Thus, the annular space between the two tubes serves to supply the cutting piston with suction and air pressure pulses and the inner tube supplies suction and conducts the debris out of the eye and into a measuring cylinder.

The pull-cut instrument has the same dimensions and weight as the push-out instrument as previously mentioned but instead of cutting on the outward stroke of the inner tube this tube cuts on its inward stroke. Thus, the inner tube is, in this case, provided with the port and the material sucked into the port is sheared off by the sharpened end of the outer tube. In this case the outer tube is slit and is sprung inward so that it forms a tight fit against the outer surface of the inner tube. Also in this case the inner tube'may be provided with two opposing ports thereby permitting easier flow of ment is slidable in this quartz tube so that the cutting end of the electrode moves in and out of the end of the quartz a very short distance. During this in and out motion of the electrode tip any foreign matter such as coagulated protein adhering thereto is scraped off of the electrode by the end of the quartz tube. In order for this high frequency cutting instrument to function efficiently a reasonably good impedance match must be provided between it and the high frequency coaxial transmission line and in our invention we have provided such an impedance match in the handle of the device by adjusting the material of the dielectric sleeve and the diameter of the extendable flexible conductor.

In order to reduce the diameter of the high frequency cutting probe a metal tube may be employed instead of vitreous or other-material into it. The pull-cut instrument has some advantage over the push-cut device, but it has the disadvantage that the inner tube must protrude about three-fourths'mm. from the outer tube on each stroke. In all other respects the operations of both of the units are equally effective with the pull-cut instrum'entbeing lessvulnerable to dulling of its cutting edge during assembly; However, with care either unit can be disassembled and reassembled without damage or difficulty.

The high frequency electrical cutting instrument that we have provided in this invention employs a radio frequency electrical supply and may be used equally well on frequencies between l3 megaI-Iertz and 140 mega- I-Iertz. The source of high frequency power may be either of the thermionic variety or the solid state variety, however, the solid state is preferred because of its greater safety under all operating conditions. The radio frequency current is supplied to the cutting electrode through an impedance matching network and a coaxial the fused quartz tube. Metals such as iridium or a platinum-iridium alloy may be used for this purpose because of its high strength, stiffness, hardness and chemical inertness. A metal tube having an outside diameter of 0.01 inches (0.25 mm.) is suitable for this purpose and this tube is provided with a coating of fluorocarbon plastic of 0.002 to 0.003 inches thickness. Such a tube is flexible enough so that is may not be necessary to provide a flexible hinge between it and the handle of the instrument as may be required in the case where a sleeve of fused quartz is used as previously described.

Further details and features of this invention will be set forth in the following specification, claims and drawings in which briefly:

FIG. 1 is a perspective view of an embodiment of this invention;

FIG. 2 is a schematic diagram showing the various controls provided to this apparatus;

FIG. 3 is a side view of the pneumatic control device provided to this invention;

"FIG. 4 is a sectional view of the control device shown in FIG. 3;

FIG. 5 is an enlarged view of the pull-type vitreous cutting device;

FIG. 6 is'an exploded view showing the partsof the vitreous cutting device shown in FIG. 5;

FIG. 7 is a sectional view taken along the line 7-7 of FIG. 6; 7

FIG. 8 is a sectional view taken along the line 8--8 of FIG. 6;

FIG. 9 is a sectional view taken along the line.9--9 of FIG. 6;

FIG. 10 is a greatly enlarged view of the cutting end of the pull-type device shown in FIGS. 5 and 6;

FIG. 11 is a greatly enlarged view of a modified form of the pull-type vitreous cutting device;

FIG. 12 is an enlarged view in perspective of the push-type vitreous cutting device;

FIG. 13 is an exploded view greatly enlarged of the cutting end of the device shown in FIG. 12;

FIG. 14 is a longitudinal sectional view of the device shown .in FIG. 13 with the cutting elements assembled;

FIG. 17. is a longitudinal sectional view of the device shown in FIG. 16;

FIG. 18 is an exploded view of the device shown in FIGS. 16 and 17; and

FIG. 19 is a schematic view of a system for injecting normal saline solution or other liquid into the eye as material is removed from the eye.

Referring to the drawing in detail reference numeral designates a cabinet for housing various controls such as shown in FIG. 2 of the drawing and provided to this apparatus. The motor 11 which is mechanically connected to the-vacuum pump 12 and air pressure pump 13 is housed in the cabinet 10 together with the pumps 12 and 13 which are connected by suitable tubes to the tanks 14 and 15, respectively. A vacuum gauge 16 is connected by suitable tube to the tank 14 and a pressure gauge 17 is connected by a suitable tube to the pressure tank 15. These gauges are located on the front panel of cabinet 10 so that the dials thereof are visible to the operator. The motor 11 is connected to a suitable source of electric power such as is available in the conventional wall outlet and a switch 18 is provided on the panel of the cabinet for turning the motor on and off. An auxiliary switch 19 is provided between the power line and the D.C. power supply 20 which converts the alternating current supplied thereto to direct current for energizing the multivibrator 21 andflip-flops 22 and 23.

Multivibrator, 21 is provided for triggering the flipflop 22 which produces an output designated as mode A signal which may be supplied to the gate 24 through switch 25 when it is desired to actuate the solenoid-26 driving the valve 27 in this. mode. In mode A the valve 27 is actuated to connect the, output line 28 for equal intervals tothe vacuum line 29 and the pressure line 30 alternately. When the switch 25 is shifted to connect the output of flip-flop 22 to flip-flop 23 then the apparatus is operated in mode B and the wave form of this mode is supplied to the gate 24 and to solenoid 26 for controlling the valve 27 in accordance with this mode. In mode B the valve 27 is operated so that it connects the output line 28 to the vacuum or suction line 29 for an interval approximately three times as long as the interval during which this line 28 is connected to the pressure line 30. On the other hand the mode B signal may be used to connect output line 28 to the pressure line 30 for a longer interval than the interval during which it is connected to the vacuum line, if desired.

The desired mode may be selected by operating the switch 31 that is connected to the control box 32. This switch is shown positioned-on the front panel of the cabinet 10 although a suitable foot control may be provided for actuating this switch. A variable resistor 33 which may also be varied by a conventional foot control, is connected to the multivibrator 21 for controlling the frequency of the pulses in modes A and B. Multivibrator 21 supplies electrical pulses for triggering flip-flop 22 and thus controls the frequency of the pulses produced by this flip-flop. The variable resistor 33 may also be provided with a foot control although it is shown as being controlled by the knob 33a provided on the front panel of the cabinet.

Theline 28 is connected to the fitting 28a which is attached to the front panel of the cabinet. This fitting is of the quick disconnect Luer type so that the line or tube 28b provided between it and the vacuum control device 34 may be readilydisconnected therefrom. The vacuum control device 34 which is shown in detail in FIG. 4, is provided with a T-connection 35 having two arms 35a and 35b and line 28b is connected to arm 35a. Arm 35b is connected to line 36 which may be connected either to the inlet 37 or inlet 38 of the control device 34 for purposes which will be described more fully hereinafter. The control device 34 is provided with a piston 39 of plastic that is slidable in the cylinder 40 and the ports 37 and 38 lead into this cylinder, one port 37 leading in below the piston 39 and the other port 38 leading in at the top end thereof, and the purpose of this will also be described hereinafter.

A piston rod 41 which is also plastic is attached to the piston 39 and extends into a small cavity 42 into which the small tube 43 also extends. This end of the tube 43 is carefully lapped and polished and provides a seat for the end of rod 41. Thus the lapped and polished end of tube 43 is alternately opened and closed by the end of the piston rod 41 as the piston 39 is moved back and forth during the operation of this device. The Luer type fitting 44 is attached to the control device 34 and provides a connection between the small cavity 42 and the cylinder 45 which may be of 5 cc. capacity calibrated in one-tenth cc. increments to measure the vitreous or other material removed from the eye 'of the patient. The standpipe 45a in cylinder 45 is connected by the line 46 to the top of the waste overflow bottle 47. The bottle 47 is also connected to the vacuum line 48 so that vacuum isprovided therein.

The vacuum control device 34 is also provided with an extension neck 49 and the small tube 43 which has an outer diameter of 0.6 mm., is concentric with the extension neck 49. Tube 43 extends outward beyond extension 49 so that a small debris tube 50 is attached to the projecting part of the small tube 43. The tube 50 is positioned inside of the tube 51 and this latter tube is I attached to the projection 49 of the device 34. The

tubes 50 and 51 are attached to a cutting and debris extracting device such as indicated at 52 which may be either of the type indicated at 53 shown in FIGS. 5 to 11 or of the type indicated at 54 shown in FIGS. 12 to 15. On the other hand a high frequency electric cutting device 55 such as shown in FIGS. 16 to 18 maybe connected to the fitting 28, shown on the front of the cabinet 10, instead of the tube 28b so that the cutting device 55 may be used instead of the cutting devices 53 or 54.

The pull cut device 53 shown in FIGS. 5 to 11, inclusive, is provided with a housing 56 which also functions as a handle and which has a tubular projection 57 at one and thereof. The plastic tube 51 is attached to pro jection 57 so that alternate air and suction pulses according to either mode A or mode B are provided on the inside of this housing to operate the piston 58 which is slidably positioned in the housing 56. Piston 58 is made of fluorocarbon plastic and one end thereof is indented to receive the nut 59 which engages the enlarged threaded portion 61 of the debris tube. The portion 60 of the debris tube extends out of the piston and is inserted into the small hose or line 50 through which the debris is exhausted from the small stainless steel tube 62. I

The piston 58 is provided with a flag 63 which projects from one end thereof and slides in slot 63b which is provided tov the cap 64. This flag keeps the piston from rotating with respect to the cap. The cap 64 is provided with a knob 65 that is received by slot 66 of the housing 56 when this cap is attached to the housing. Thus, the flag 63 serves to orient the piston 58 with respect to the cap 64 and the knob 65 serves to orient the cap 64 with respect to the housing 56. The purpose of this will be described hereinafter. The cap 64 is provided with four radially extending holes 67 which are adapted to be aligned with corresponding holes in the housing 56 toprovide venting of the inside of the housing during operation of this device. Thus, by providing four such holes it is not possible for the operator of this device to cover all of the holes simultaneously during use of this device so as to interfere with the operation thereof. Suitable threaded holes 68 are provided in the cap 64 and the screws 69 are threaded into these holes through suitable apertures in the housing 56 when the cap is assembled withthe housing.

. A tubular extension 70 is provided to the outside end of the cap 64 for receiving the stainless steel tube 71. The outer end of the tube or sleeve 71 is tapered and sharpened at 72 as shown in FIG. 10. The outer end of the sleeve 71 is also provided with slots 73 so that the opposite sections of this outer end may be slightly bent towards each other. Thus the sharp cutting edge 72 of the sleeve provides sharp'shearing action with the sides ofthe holes 74 which are provided in the inner sleeve 62. The shearing action takes place as the inner sleeve is moved inward with respect to the outer sleeve 71 by the piston 58 so that the sharp edge 72 sweeps across the holes 74 and severs any vitreous sucked into the holes 74. The end of the tube 62 is welded and ground as shown at 62b to close theend of the tube at this point and give this end a rounded configuration.

It will be noted that the slots 73 are aligned with the ribsof tubes 62 between the holes 74 and this alignment is maintained by the flag 63 which is slidable in the recess 63b of the cap 64 when'the piston 58 moves back and forth, in the housing by the compressed air and suction pulses supplied to the cylinder and piston through the tube 51. Suction is supplied to the inner sleeve 62 through the tube 50 so that debris cut from the inside of the eye is exhausted through the holes 74 formed in the sleeve 62 and through this sleeve and tube 50. 'f

A modified form of the pull-type cutting device is shown in FIG. 11 in which the tube 71a corresponds to the tube 71 of FIG; and the inner sleeve 62a corresponds to the sleeve 62 of FIG. 10. The device shown in FIG. 11 is provided with a triangular shaped cutting hole 74a through which material to be removed is sucked into the sleeve 62a and this material is severed by the sharp cutting edge of the outer sleeve 71a. A slot 73a is provided to the sleeve 71a so that the end portion of this sleeve may be slightly compressed to provide a tight fit between it and the sleeve 62a and facilitate the cutting of the material drawn into the tube 62a, when this tube ismoved into sleeve 71a and desired shearing action is obtained between thesharp cutting edges 72a and 14a. I

Anotherformof this device which is the push type cutting embodiment, is shown in FIGS. 12, 13, 14 and 15.. Certain parts of this device provided in the housing 76 are the same as corresponding parts provided in the housing 56 of the pull type device shown in FIG. 5. The device shown in FIGS. 12 through 15, inclusive, differs from that shown in FIGS. 5 to 11, inclusive, in that the outer sleeve 75 which is fixedly attached to the cap 64 is provided with an inner sleeve 77 which has the end 79 thereof tapered and honed to a sharp cutting edge. The outer sleeve 75 is provided with an opening at the outer end portion thereof which is tapered and honed to a sharp edge so that when the inner sleeve 77 is moved outward these sharp cutting edges 78 and 79 cooperate to shear off any vitreous or. other material that has been sucked into the sleeve. In order to produce this desired shearing action the inner sleeve 77 is provided with a slot 80 so that the end portion of this inner sleeve is expanded slightly and provides a close fit between it and the inner wall of the outer sleeve 75.

The device 55 shown in FIGS. l6, l7 and 18 is an example of a cutting device in which high frequency electric current is supplied to a self-cleaning electrode. This device is provided with a tubular housing 81 having an air and suction inlet member 82 attached to the side thereof. One end of the air and suction line 83 is attached to the inlet member 82 and the other end is attached to the fitting 28a provided to the cabinet 10 shown in FIG. 1 after the other line 28b is detached from this fitting. Air and suction pulses according to mode A or B are supplied to the inside of the device 55 through the inlet member 82 and the hole 84 aligned therewith which communicates with the inside of the tubular housing 81 through the plug 85. This plug is of insulation material'and it is attached to the end of the tubular housing 81 by suitable bayonet-type attaching means. High frequency coupling member 86 is attached to the plug and this member is of insulating material so that the electrode 87 positioned therein is insulated from the tubular housing. The electrode 87 is connected to the flexible conductor 88 which is of conventional braided-type and a suitable source of high frequency of conventional design is connected to the electrode 87 by a coaxial cable of predetermined impedance. One end of the braided copper-wire conductor 88 is soldered to the small bolt or screw 89 and the other end is soldered into the sleeve .91. One end of the coil spring 90 abuts the inner end of the plug 85 and the other end of the coil spring abuts the insulation sleeve 92 that is positioned in the tubular housing 81. The other end of this insulation sleeve abuts the shoulder provided inside of the tubular housing 81 as shown in FIG. 17. The screw 89 is inserted into the piston 93 of fluorocarbon plastic material. Piston 93 is slidable inside of the housing 81 and it is moved through a short stroke of about 1% mm. by the compressed air and suction pulses supplied thereto through-the pneumatic line 83. The piston 93 is held on the screw 89 by the nut 94 and it is attached to another nut 95 which functions as a chuck for the electrode wire 96. Electrode wire 96 is provided with a small knob 97 at the end thereof and this knob is pressed against the end of the screw 89 when the chuck-95 is attached to the screw. Electrode wire 96 passes through the central hole provided in the insulation plug 98. Plug 98 is provided-with threads 99.

and is attached thereby to the tubular housing 81. Another plug 100 is attached by threads 101 to the plug 98 and a short plastic tube 102 is attached in the central hole provided to plug 100. One end of the insulation sleeve 103 which is of quartz coated with a plastic such as Teflon is inserted into the plastic tube 102 up to the constricted part 104. The plastic tube 102 is provided with the constricted portion 104 to increase the flexibility thereof so that the tube 103 may be moved slightly in the direction of the arrows shown in FIG. 16

by flexing the tube 102 at the area 104. The electrodewire 96 passes through the tube 103 and during the back and forth movement of the piston 93 a small portion of the electrode wire 96 is exposed at the free end of the sleeve 103. The amount of this exposure may be controlled by adjusting the plug 100 with respect to the plug 98. However, as the electrode wire 96 is moved back and forth the outer end thereof is cleaned by the outer end of the sleeve 103 so that material such as coagulated protein adhering to the electrode wire 96 is scraped therefrom by the end of the sleeve 103.

In FIG. 19 there is shown an arrangement for automatically injecting normal saline solution or other liquid into the eye of the patient as material is removed therefrom. This arrangement includes an L or hookshaped conduit 105 which has a diameter of 0.6 mm. or less and which is hooked into the eye of the patient so that it is self retaining. The conduit 105 is connected by the plastic tube 106 to a bottle 107 of saline solution which is supported well above the patient so that the solution feeds into the patients eye as vitreous or other material is removed therefrom to replace such removed material and maintain a predetermined pressure. Conduit 105 is designed to fit snugly against the eyeball with a low profile so that it is out of the way of viewing and possible snagging of objects. This conduit could be made of various materials such as metal, plastic, fused quartz or glass.

While we have shown and described a preferred form of the invention, it will be apparent that the invention is capable of modification and variation from the form shown, so that the scope thereof should be limited only by the proper scope of the claims appended hereto.

What we claim is:

1. In an apparatus for intraocular surgery such as cutting or severing and removal of vitreous or other material from theeyeball of a patient, the combination of a vitreous cutting'and removing device, a pair of telescoping tubular members, means moving one of said tubular members back and forth with respect to the other during the vitreous cutting operation, one of said tubular members having a hole for receiving vitreous to be severed and removed from the eye and the other of said tubular member having one end thereof sharpened to shear the vitreous entering said hole, means attached to the-inner one of said telescoping tubular members for removing the severed vitreous, said moving means comprising sources of compressed air and vacuum and pneumatic actuating means connected to said movable tubular member, means connected to said sources alternately for reciprocating said pneumatic actuating means and said movable tubular member, said means attached to said inner tubular member comprising a hose and means connecting said hose to said source of vacuum.

2. In an apparatus for intraocular surgery such as cutting or severing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 1, further characterized in that said means connecting said hose to said source of vacuum comprises a vacuum control valve periodically actuated by compressed air and vacuum.

3. In apparatus for intraocular surgery for cutting or severing and removal of vitreous or other material from the eyeball of a patient, the combination comprising a tube of very small diameter having a hole near one end thereof, a second tube concentric with said first mentioned tube, said tubes fitting snugly together and one of said tubes being slidable with respect to the other, the end of said second tube being honed and polished to provide a sharp cutting edge, means connected to said tubes drawing vitreous into said hole of said first mentioned tube, means for moving said one of said tubes so that the sharp end thereof crosses said hole and shears said vitreous sucked into said hole of said first mentioned tube, a handle comprising a cylinder with a piston slidable therein, means connecting said one of said tubes to said piston and pneumatic means for moving said piston back and forth.

4. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 3, further characterized in that said one of said tubes that is connected to said piston comprises the tube with said hole near one end thereof and said one of said tubes being slidable inside of said second tube.

5. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyball of a patient, the combination as set forth in claim 3, further characterized in that said one of said tubes that is connected to said piston comprises said second tube and said second tube being slidable in said first mentioned tube.

6. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 3, further characterized in that said pneumatic means comprises sources of airpressure and vacuum, and means alternately connecting said sources to the said cylinder for actuating said piston.

7. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 3, further characterized in that said pneumatic means includes a pair of small flexiblehoses one of which supplies pressure and vacuum from said sources to actuate said piston and the other of which is connected to the inner one of the cutting tubes for removal of debris resulting from the cutting operation.

8. In apparatus for intraocular surgery for cutting or shearing and removal of vitreous or other material from the eyeball, the combination of a vitreous cutting device comprising a pair of tubes of very small diameter, the end of one of said tubes being'honed and polished to provide a sharp cutting edge and the other ofsaid tubes being provided with a hole for receiving vitreous to be severed and removed from the eye, said tubes being concentric and one of said tubes being slidable with respect to the other so that said sharp cutting edge traverses said hole, means generating a pulsating electric current, means controlling the frequency of said pulsating electric current, pneumatic apparatus comprising a vacuum pump and an air pressure pump, a pneumatic line and means connecting said line to said cutting device, a two-way valve connected to said pneumatic line, means connecting said valve to said pressure pump and to said vacuum pump, means responsive to said pulsating current for operating said valve and alternately connecting said pneumatic line to said source of air pressure and to said source of vacuum through said two-way valve, said cutting device having means responsive to alternate air pressure and vacuum pulses transmitted through said pneumatic line.

9. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set said second pneumatic line to said vacuum pump includes a pneumatically operated valve.

11. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 10, further characterized in that said pneumatically operated valve comprises a vacuum control valve operated by a piston slidable in a cylinder, and means connecting said cylinder to said two way valve to supply air pressure and vacuum thereto alternately. 

1. In an apparatus for intraocular surgery such as cutting or severing and removal of vitreous or other material from the eyeball of a patient, the combination of a vitreous cutting and removing device, a pair of telescoping tubular members, means moving one of said tubular members back and forth with respect to the other during the vitreous cutting operation, one of said tubular memberS having a hole for receiving vitreous to be severed and removed from the eye and the other of said tubular member having one end thereof sharpened to shear the vitreous entering said hole, means attached to the inner one of said telescoping tubular members for removing the severed vitreous, said moving means comprising sources of compressed air and vacuum and pneumatic actuating means connected to said movable tubular member, means connected to said sources alternately for reciprocating said pneumatic actuating means and said movable tubular member, said means attached to said inner tubular member comprising a hose and means connecting said hose to said source of vacuum.
 2. In an apparatus for intraocular surgery such as cutting or severing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 1, further characterized in that said means connecting said hose to said source of vacuum comprises a vacuum control valve periodically actuated by compressed air and vacuum.
 3. In apparatus for intraocular surgery for cutting or severing and removal of vitreous or other material from the eyeball of a patient, the combination comprising a tube of very small diameter having a hole near one end thereof, a second tube concentric with said first mentioned tube, said tubes fitting snugly together and one of said tubes being slidable with respect to the other, the end of said second tube being honed and polished to provide a sharp cutting edge, means connected to said tubes drawing vitreous into said hole of said first mentioned tube, means for moving said one of said tubes so that the sharp end thereof crosses said hole and shears said vitreous sucked into said hole of said first mentioned tube, a handle comprising a cylinder with a piston slidable therein, means connecting said one of said tubes to said piston and pneumatic means for moving said piston back and forth.
 4. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 3, further characterized in that said one of said tubes that is connected to said piston comprises the tube with said hole near one end thereof and said one of said tubes being slidable inside of said second tube.
 5. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyball of a patient, the combination as set forth in claim 3, further characterized in that said one of said tubes that is connected to said piston comprises said second tube and said second tube being slidable in said first mentioned tube.
 6. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 3, further characterized in that said pneumatic means comprises sources of air pressure and vacuum, and means alternately connecting said sources to the said cylinder for actuating said piston.
 7. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 3, further characterized in that said pneumatic means includes a pair of small flexible hoses one of which supplies pressure and vacuum from said sources to actuate said piston and the other of which is connected to the inner one of the cutting tubes for removal of debris resulting from the cutting operation.
 8. In apparatus for intraocular surgery for cutting or shearing and removal of vitreous or other material from the eyeball, the combination of a vitreous cutting device comprising a pair of tubes of very small diameter, the end of one of said tubes being honed and polished to provide a sharp cutting edge and the other of said tubes being provided with a hole for receiving vitreous to be severed and removed from the eye, said tubes being concentrIc and one of said tubes being slidable with respect to the other so that said sharp cutting edge traverses said hole, means generating a pulsating electric current, means controlling the frequency of said pulsating electric current, pneumatic apparatus comprising a vacuum pump and an air pressure pump, a pneumatic line and means connecting said line to said cutting device, a two-way valve connected to said pneumatic line, means connecting said valve to said pressure pump and to said vacuum pump, means responsive to said pulsating current for operating said valve and alternately connecting said pneumatic line to said source of air pressure and to said source of vacuum through said two-way valve, said cutting device having means responsive to alternate air pressure and vacuum pulses transmitted through said pneumatic line.
 9. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 8, further comprising a second pneumatic line, means connecting said second pneumatic line to the inner one of said concentric tubes, means periodically connecting said second pneumatic line to said vacuum pump for removing debris from said inner tube.
 10. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 9, further characterized in that said second pneumatic line is inside of said first mentioned pneumatic line and said means periodically connecting said second pneumatic line to said vacuum pump includes a pneumatically operated valve.
 11. In an apparatus for intraocular surgery such as cutting or shearing and removal of vitreous or other material from the eyeball of a patient, the combination as set forth in claim 10, further characterized in that said pneumatically operated valve comprises a vacuum control valve operated by a piston slidable in a cylinder, and means connecting said cylinder to said two way valve to supply air pressure and vacuum thereto alternately. 